need help writing psychosocial nursing dx based on developmental tasks

[mb09]

Hi...I'm desperately hoping that someone can help me out because I'm not grasping the concept of nursing dx based on developmental tasks...(i.e. trust v mistrust etc). Also, these obviously have to be patient focused NOT parent related. The parents are obviously a part of our interventions, but the nursing dx cannot be r/t to them. Anywho.. I've got an unfortunate pt who is 8 years old (her developmental task is industry v inferiority) she is developmentally behind so she may be between stages however, we're supposed to focus on where they should be.

her HPI is as follows: she has a h/o seizure disorder, on 1/12/09 she was found with clenched hands, moaning in bed, +salivation, + tongue biting, no loss of bowel/bladder..she was taken to hospital..etc

prior to event pt had been developing her gross motor skills appropriately but had delay in visual motor and fine motor dexterity (age equiv 4-5 years) has social perceptive issues-does not understand sarcasm & if people are laughing at something she doesn't understand she gets upset & believes they are laughing at her.

possible psychosocial nursing dx based on industry v inferiority that I have come up with are as follows:

1.) Risk for chronic low self esteem r/t social isolation

2.) Impaired social interactions r/t anxiety amb pt gets upset if laughing around her and she does not understand what the laughter is about

3.) Risk for Social isolation r/t prolonged hospitalization

4.) Risk for lonlieness r/t social isolation from peers secondary to prolonged hospitalization and impaired social interactions

Let me know what you guys think!! PLEASE HELP! I'm 2 months from graduation!

[Daytonite, BSN, RN]

the developmental stage of industry vs inferiority is where the school age child is trying to develop a sense of self-worth by refining different skills. you can find information on specific developmental milestones for school age children on the pediatric weblinks on this thread: https://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html

"risk for" diagnoses are almost never sequenced first unless they are a safety issue (such as risk for suicide). i'm curious as to why you didn't consider a diagnosis of delayed growth and development r/t prolonged physical illness at early age aeb delays in visual motor and fine motor dexterity and social perceptive issues. ([color=#3366ff]delayed growth and development) i would sequence that diagnosis first because of the visual and motor evidence you have. also, with a history of seizures the patient is at a risk for injury and probably has mental cognition issues.

1. impaired social interactions r/t anxiety amb pt gets upset if laughing around her and she does not understand what the laughter is about

your related factor, however, is incorrect.

anxiety

is a whole other nursing diagnosis. the reason (cause, etiology) that there is

insufficient or excessive quantity or ineffective quality of social exchange

(the definition of this diagnosis) is what? her developmental delay? mental retardation? or, cognition issue? the fact that she gets upset when there is laughing around her is a defining characteristic (or symptom) of the diagnosis. that makes the other "risk for" diagnoses subordinate to this actual problem.

2. risk for loneliness r/t social isolation from peers secondary to prolonged hospitalization and impaired social interactions

3. risk for social isolation r/t prolonged hospitalization

how can you have a risk factor for loneliness of social isolation and turn around and say the patient is at risk for social isolation to occur. is social isolation present or not? if social isolation is present then she has a

risk for loneliness

, but cannot be at

risk for social isolation

because it is already present. if social isolation is not present then her

risk for loneliness

must be related to something else other than social isolation.

4. risk for chronic low self esteem r/t social isolation

people have low self-esteem when they haven't had much interaction with other people (they

may

have been socially isolated). the related factor is the cause (etiology) or why this happened. in this case it was because of her prolonged hospitalization that resulted in stunting her opportunities to learn how to interact normally with people. we learn how to interact with people by doing it on a regular basis. when children are hospitalized their only interactions are with adult caregivers so their development in this regard is not normal. so, for this patient it is

risk for chronic low self-esteem r/t prolonged hospitalization.